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The V-shaped subscapularis tenotomy for anatomic total shoulder arthroplasty

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Abstract

Purpose

Management of the subscapularis tendon during anatomic total shoulder arthroplasty (TSA) remains controversial. In our unit, subscapularis tenotomy is the preferred technique; however, the potential for tendon gapping and failure is recognised. The purpose of this study is to describe and provide early clinical results of a novel, laterally based V-shaped tenotomy (VT) technique hypothesised to provide greater initial repair strength and resistance to gapping than a transverse tenotomy (TT), with both clinically and radiologically satisfactory post-operative tendon healing and function.

Methods

A retrospective study of patients who underwent primary TSA with VT over a three year period was performed using shoulder and subscapularis-specific outcome scores, radiographs, and ultrasound. A separate cohort of patients who underwent TSA using a subscapularis sparing approach was also reviewed to provide comparative clinical outcomes of a group with TSA and an un-violated subscapularis.

Results

Eighteen patients were reviewed at mean 30.4 months (± 11.7). Constant (78.2 ± 12.3), UCLA (8.4 ± 1.5), pain VAS (2.3 ± 2.8), and strength in internal rotation were no different from the comparison group. Likewise, neither were the clinical outcomes of range-of-motion, belly-press, lift-off, and shirt-tuck tests. One patient (5.5%) was found to have a failed subscapularis repair on ultrasound.

Conclusion

VT during TSA appears to provide healing rates at least equal to those reported for TT, and not dissimilar from those of lesser tuberosity osteotomy. Clinical outcomes are comparable to reported results in the literature for alternative techniques, and not different from those observed here in a comparison cohort with TSA performed without violating the subscapularis tendon.

VT therefore potentially offers a more effective and secure tendon repair than a traditional TT, with at least comparable clinical outcomes.

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Acknowledgements

This paper presents independent research supported by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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Authors and Affiliations

  1. Alps Surgery Institute, Clinique Générale d’Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France

    Daniel J. H. Henderson, Thomas J. Christensen, Austin Vo, Johannes E. Plath, Ion-Andrei Popescu & Laurent Lafosse

  2. Department of Trauma & Orthopaedics & Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, LS7 4SA, UK

    Daniel J. H. Henderson

  3. Reno Orthopaedic Clinic, Reno, NV, USA

    Thomas J. Christensen

  4. Austin & Monash Health, Melbourne, Australia

    Austin Vo

  5. Department of Trauma, Orthopaedic, Plastic & Hand Surgery, Zentralklinikum, Augsburg, Augsburg, Germany

    Johannes E. Plath

  6. European Shoulder & Hand Unit, Bucharest, Romania

    Ion-Andrei Popescu

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  1. Daniel J. H. Henderson
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  2. Thomas J. Christensen
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Correspondence to Daniel J. H. Henderson.

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Conflict of interest

L.L. is a consultant for DePuy/Mitek, Stryker, and OrthoSpace.

I-A.P and J.E.P. have participated in a shoulder fellowship programme sponsored by DePuy/Mitek

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the local IRB and registered with the IRB approval number CERC-S-2017-03.

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Freely given, informed consent was obtained from all patients in this study for all procedures undertaken and all data obtained.

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All work carried out at: Alps Surgery Institute, Clinique Générale d’Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France

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Henderson, D.J.H., Christensen, T.J., Vo, A. et al. The V-shaped subscapularis tenotomy for anatomic total shoulder arthroplasty. International Orthopaedics (SICOT) 45, 199–208 (2021). https://doi.org/10.1007/s00264-020-04880-8

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